| NPI | 1932980513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JARVENE SHACKELFORD Pharmacy Director 662-591-5234 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2023-10-10 |